Home oxygen referral audit in premature neonates born In UMHL

Background: Bronchopulmonary dysplasia (BPD) has been a challenging condition for neonatologists. Despite many other advances in neonatology, this is a disease for which we have made little progress (1). The primary risk factor, prematurity, is not in dispute and is quite consistent with the first report of BPD by a young Stanford radiologist (2). Prematurely born infants who had BPD may require supplementary oxygen at home for many months (3). It is observed that very few premature babies were discharged on home oxygen from University Maternity Hospital Limerick in last two years. There is no set standard practice under which home oxygen referral happens in UMHL. Most of the referrals used to be done two to three weeks before expected date of baby’s discharge if the baby was failed to achieve self ventilation at room air. Doctors used to complete the referral form and attach in the chart as an evidence of referral process. The objective of this study is to determine the number of premature babies born in UMHL who were discharged on home oxygen over two years period, so undue home oxygen referral and allocation of resources can be prevented. Further to find out average gestation age at which babies were self ventilating at room air.

Methods: Retrospective data of 38 babies equal to or less than 29 weeks of gestation was collected who were born in UMHL from February 2016 to February 2018. Charts were pulled from medical records after getting list of babies from admission book under gestation mentioned above. Different variables were studied including Gestation at birth, Birth weight, Date of admission, Date of discharge, Gestation for self ventilation at room air, Gestation of home oxygen referral and gestation at discharge. Further to this, management of Chronic Lung Disease in the form of steroids and diuretics treatment along with management of patent ductus arteriosus and number of required blood transfusions were also looked upon.

Results: This study showed total 38 babies born in UMHL from February 2016 to February 2018, equal to or less than 29 weeks of gestation. 26%(n=10) babies were excluded from the study including 21%(n=8) babies died, 3%(n=1) chart missing and 3%(n=1) baby lost follow up. In remaining 28 babies, out of which 71%(n=20) were born in the gestation range of 26 to 28 weeks and 70%(n=19) were between birth weight of 750 grams to 1250 grams. 59%(n=16) babies were self ventilating at room air between 31 to 35 weeks of gestation and only 11%(n=3) were self ventilated at room air over 41 weeks of corrected gestational age. 70%(n=19) babies were discharged home within two to four weeks of achieving self ventilation at room air. 29 %(n=8) of the babies didn’t need any intervention (Diuretics, Steroids, PDA management, Blood transfusion) during their stay in NICU while 29%(n=8) needed just one intervention among the list mentioned above. 43%(n=12) of the babies needed two or more interventions to achieve self ventilation at room air during their stay in the hospital. This study showed that 4%(n=1) babies were not able to wean off from oxygen over two years period. This baby was discharged home at 42 weeks of corrected gestation age after 14 days of sending home oxygen referral.

Conclusion: It is concluded from this study that only one baby out of total 28 was discharged on home oxygen over two years period and home oxygen referral was sent two weeks before discharge. Further, most of the babies were able to achieve self ventilation at room air between 31st to 35th weeks of gestation while other took little longer to achieve the same.